• Jennifer A Nicholas, Bu B Yeap, Donna Cross, and Melanie S Burkhardt.
• Medical School, University of Western Australia, Perth, Western Australia, Australia.
• Intern Med J. 2022 Jun 1; 52 (6): 952958952-958.

BackgroundDiabetes distress, self-efficacy and health literacy are associated with diabetes self-management and health outcomes. Measures of coping styles and their impact on diabetes self-management and diabetes-related distress might add value in identifying those at risk of poorer health outcomes. Current evidence of associations between psychological flexibility/inflexibility and diabetes-related health outcomes is limited.AimsTo measure associations of psychological flexibility, self-efficacy and health literacy with diabetes distress and glycated haemoglobin (HbA1c) in adults with type 1 diabetes.MethodsWe surveyed 105 adults with type 1 diabetes attending a tertiary diabetes outpatient clinic (mean age 27 ± 7.1 years; 53% men; duration of diabetes 12.6 ± 8.5 years; HbA1c 72 ± 22 mmol/mol, 8.7 ± 2.0%; 34% using insulin pumps). We assessed psychological flexibility, self-efficacy, health literacy and diabetes distress. Regression models explored the relative contributions of different factors to diabetes distress and HbA1c.ResultsThe majority of health literacy scores were in the low-risk range. Those with greater psychological flexibility had higher self-efficacy (r = 0.34; P < 0.01) and reported less diabetes distress (r = -0.54; P < 0.001). In multiple regression analyses, psychological flexibility and self-efficacy accounted for 36% of the variance in distress score (P < 0.001). Shorter duration of diabetes (P < 0.001) and greater psychological flexibility (P < 0.01) correlated with lower HbA1c. A 10-point (one standard deviation) higher psychological flexibility score corresponded to a 0.5% lower HbA1c.ConclusionsGreater psychological flexibility was associated with less diabetes distress and lower HbA1c. The psychological flexibility construct might inform alternative interventional approaches aiming to improve well-being and glycaemic control.© 2021 Royal Australasian College of Physicians.

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